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General NPI Number Information
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NPI Number | 1821284589
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Entity Type | Organization
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Legal Business Name | M.W. KILGORE, II, M.D., P.A.
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 11363 SAN JOSE BLVD SUITE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7957
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Country | US
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Telephone | 904-396-2400
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Fax | 904-396-3750
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Provider Business Mailing Address
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Address Line | 11363 SAN JOSE BLVD SUITE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7957
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Country | US
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Telephone | 904-396-2400
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Fax | 904-396-3750
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MANLEY W KILGORE II
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Credential |
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Telephone | 904-396-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME17133
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License Number State | FL
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